Provider Demographics
NPI:1598833352
Name:RODRIGUEZ, VIVIAN (MSW, DCSW, CAC III,)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW, DCSW, CAC III,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 CALLE DRESDE
Mailing Address - Street 2:VILLA BORINQUEN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-3708
Mailing Address - Country:US
Mailing Address - Phone:787-792-0278
Mailing Address - Fax:787-792-0278
Practice Address - Street 1:518 CALLE DRESDE
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-3731
Practice Address - Country:US
Practice Address - Phone:787-792-0278
Practice Address - Fax:787-792-0278
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2740104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660535585OtherTAX ID #
PR660535585OtherTAX ID #